title: The system of the modified transcochlear approach: a lateral avenue to the central skull base.
abstract: OBJECTIVE
  This study aimed to update the authors' experience with the modified transcochlear approach for the management of lesions of the central skull base. The surgical technique, classification, indications, and results also are presented.
  
  
  METHODS
  A retrospective review of the charts of 66 consecutive patients treated in our centers by the modified transcochlear approach was conducted.
  
  
  METHODS
  The study was performed in two tertiary referral centers.
  
  
  METHODS
  All patients treated by the modified transcochlear approach were included. Thirty-five patients had extradural lesions, whereas 31 lesions were intradural.
  
  
  METHODS
  All patients were treated surgically using the modified transcochlear approach either in its basic form (type A) or with its extensions (types B, C, and D).
  
  
  METHODS
  The outcome of surgery is evaluated with particular emphasis on the incidence of morbidity, mortality, and the degree of total tumor removal.
  
  
  RESULTS
  Total tumor removal was accomplished in 58 cases either in single or staged procedures. A second-stage procedure for total tumor removal is planned in five other patients. Subtotal tumor removal was performed in three patients. Mortality occurred in two cases. Ipsilateral hearing loss and immediate facial nerve palsy constituted the major drawbacks of this approach. However, 67.5% recovered to grade III facial function or better 1 year after surgery.
  
  
  CONCLUSIONS
  The modified transcochlear approach provides a relatively safe, wide, and versatile access to large lesions of the central skull base.
authors.affiliation: Gruppo Otologico, Piacenza, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sanna
authors.forename: A
authors.initials: A
authors.lastname: Mazzoni
authors.forename: E
authors.initials: E
authors.lastname: Saleh
authors.forename: A
authors.initials: A
authors.lastname: Taibah
authors.forename: F
authors.initials: F
authors.lastname: Mancini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002648:Child; D002781:Cholesteatoma / Q000473:pathology / Q000601:surgery; D003051:Cochlea / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010579:Petrous Bone / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery